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Aortic Graft Mycotic Pseudoaneurysm as a Severe Complication After Multivisceral Transplantation: A Case Report. [caso clínico]

Por: Calvo Pulido, Jorge [Cirugía General y del Aparato Digestivo] | Manrique Municio, Alejandro [Cirugía General y del Aparato Digestivo] | Loinaz Segurola, Carmelo [Cirugía General y del Aparato Digestivo] | Justo Alonso, Iago [Cirugía General y del Aparato Digestivo] | Caso Maestro, Óscar [Cirugía General y del Aparato Digestivo] | García-Sesma Pérez-Fuentes, Álvaro [Cirugía General y del Aparato Digestivo] | Cambra Molero, Félix [Cirugía General y del Aparato Digestivo] | San Juan Garrido, Rafael [Medicina Interna] | Abradelo de Usera, Manuel [Cirugía General y Aparato Digestivo] | Marcacuzco Quinto, Alberto [Cirugía General y Aparato Digestivo] | Moreno González, Enrique [Cirugía General y del Aparato Digestivo] | Jiménez Romero, Carlos [Cirugía General y del Aparato Digestivo].
Colaborador(es): Servicio de Cirugía General y del Aparato Digestivo | Servicio de Medicina Interna.
Tipo de material: materialTypeLabelArtículoEditor: Transplantation proceedings, 2016Descripción: 48(2):539-42.Recursos en línea: Solicitar documento Resumen: Background: Surgical complications in multivisceral transplantation (MVT) are frequent and always severe. Those related to technical issues are relevant as they have implications not only on the graft but also on patient survival. The aim of this study was to review our case-based data and experience with 5 MVT performed since December 2004. Case report: A 38 year-old woman presented with ultra-short bowel syndrome due to massive ischemia also affecting the celiac trunk. She also had moderate to severe hepatitis/steatosis with some degree of fibrosis on liver biopsy, due to long-term home parenteral nutrition (HPN). An MVT was carried out in September 2010 including the liver, stomach, pancreatoduodenal complex with the spleen, and small bowel. The postoperative course was complicated by a leak from the pyloromiotomy, requiring reoperation on postoperative day 13. She also had central line catheter infection and renal impairment, requiring renal replacement therapy, and was discharged on postoperative day 150. Fifteen days later she was hospitalized because of severe abdominal pain associated with an abdominal mass. Computed tomography showed an aortic donor graft pseudoaneurysm, so we decided to operate on the patient. A complete resection of the pseudoaneurysm using an interposed polytetrafluoroethylene graft was performed. Six months after the MVT, the patient died due to sepsis, despite a functional graft and complete digestive autonomy. Conclusions: Although this complication is rare, surgical complications in MVT are severe and may seriously impair graft and patient survival.
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Formato Vancouver:
Calvo Pulido J, Manrique Municio M, Loinaz Segurola C, Justo Alonso I, Caso Maestro O, García Sesma A et al. Aortic Graft Mycotic Pseudoaneurysm as a Severe Complication After Multivisceral Transplantation: A Case Report. Transplant Proc. 2016 Mar;48(2):539-42.

PMID: 27109996

Contiene 10 referencias

Background: Surgical complications in multivisceral transplantation (MVT) are frequent and always severe. Those related to technical issues are relevant as they have implications not only on the graft but also on patient survival. The aim of this study was to review our case-based data and experience with 5 MVT performed since December 2004.
Case report: A 38 year-old woman presented with ultra-short bowel syndrome due to massive ischemia also affecting the celiac trunk. She also had moderate to severe hepatitis/steatosis with some degree of fibrosis on liver biopsy, due to long-term home parenteral nutrition (HPN). An MVT was carried out in September 2010 including the liver, stomach, pancreatoduodenal complex with the spleen, and small bowel. The postoperative course was complicated by a leak from the pyloromiotomy, requiring reoperation on postoperative day 13. She also had central line catheter infection and renal impairment, requiring renal replacement therapy, and was discharged on postoperative day 150. Fifteen days later she was hospitalized because of severe abdominal pain associated with an abdominal mass. Computed tomography showed an aortic donor graft pseudoaneurysm, so we decided to operate on the patient. A complete resection of the pseudoaneurysm using an interposed polytetrafluoroethylene graft was performed. Six months after the MVT, the patient died due to sepsis, despite a functional graft and complete digestive autonomy.
Conclusions: Although this complication is rare, surgical complications in MVT are severe and may seriously impair graft and patient survival.

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